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Can star ratings ever be accurate or meaningful?

On 6 June 2006, the Chairman of the Royal College of General Practitioners (RCGP), Professor Mayur Lakhani, announced a 'grading system' for GPs, which was predictably reported in the Times as 'Michelin-style stars for GPs'.1

This will undoubtedly happen at some point, since the Government is obsessed with reducing the complexities of healthcare to the simplistic system of stars and league tables. However, for the RCGP to be trapped into suggesting the scheme is the nadir in its press management.

Two days later, the RCGP bid a hasty retreat, citing fears that the grading might be used for star ratings. The BBC reported this as 'GPs Michelin grade plan scrapped'2 – but for how long?

Perhaps I'm being a little unfair. The medical establishment has been accused of not engaging the media in the past, but when it does it is often misrepresented by an industry that, like politicians, thrives on reducing everything to simplistic headlines and biased opinions.

Professor Lakhani may correctly have judged that if grading is going to be imposed anyway, the RCGP may as well be leading the process rather than leaving it to the Government to decide what form it should take.

Getting any sort of open debate in a heavily politicised health service is hard enough, but when our politicians, lawyers and journalists are so adversarial and eager to blame, it's almost impossible.

Labour has pushed through star ratings for NHS trusts, with the justification that patients have a right to know how well their hospital is doing. But are the ratings fair, valid, accurate and evidence-based?

Of course they're not – they had to be rushed through to hit a political deadline. Many zero-star trusts offer excellent clinical care but overspend, while three-star trusts balance the books by cutting services.

The next wave of proposed stars – for individual heart surgeons – has been shelved for fear of litigation more than anything, but the surgeons themselves, after much debate and deliberation, have now published their results on the web.3

This is the only way forward for the RCGP. If quality assurance is ever going to work, it has to have the input and agreement of those it affects. All GPs want to improve standards, but they don't want to be plastered all over the tabloids for not doing what the Government tells them to do.

The beauty of general practice is the freedom to practise in the way you feel best serves your patients. If you stay up all night with a terminally ill patient and miss your access target the following morning, does that make you a bad doctor?

We need to have this debate. If the RCGP wants accreditation to work, it has to inspire and motivate us, not scare us with threats that what the Government proposes will be even worse.